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Individual

LINDA G SHAW

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
FNP

Contact information

Practice address
805 N 6TH E, MOUNTAIN HOME, ID 83647-2207
(208) 587-5880
(208) 587-7905
Mailing address
805 N 6TH E, MOUNTAIN HOME, ID 83647-2207
(208) 587-5880
(208) 587-7905

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
NP382A
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010017467
REGENCE BLUE SHIELD
ID
01
NPGP8
BLUE CROSS
ID
Enumeration date
10/12/2006
Last updated
07/08/2007
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